Opinion on the development and research status of intelligent ophthalmology in China / 国际眼科杂志(Guoji Yanke Zazhi)

This paper provides a comprehensive analysis of the current state of intelligent ophthalmology in China, including technological advancements, academic exchange platforms, policy support, future challenges, and potential solutions. Technologically, remarkable progress have been made in various areas of intelligent ophthalmology in China, including diabetic retinopathy, fundus image analysis, and crucial aspects such as quality assessment of medical artificial intelligence products, clinical research methods, technological evaluation, and industrial standards. Researchers are constantly improving the safety and standardization of intelligent ophthalmology technology by formulating clinical application guidelines and standards. Academic exchange platforms have been established to provide extensive collaboration opportunities for professionals across diverse fields, and various academic journals serve as publication platforms for intelligent ophthalmology research. Regarding public policy, the Chinese government has not only established a supportive policy environment for the advancement of intelligent ophthalmology through various documents and regulations, but provided a legal basis and management framework. However, there are still challenges to overcome, such as technological innovation, data privacy and security, outdated regulations, and talent shortages. To tackle these issues, there is a requirement for increased technological research and development, the establishment of regulatory frameworks, talent cultivation, and greater awareness and acceptance of new technologies among patients. By comprehensively addressing these challenges, intelligent ophthalmology in China is expected to continue leading the industry's global development, bringing more innovation and convenience to the field of ophthalmic healthcare.

Research progress of hydroxychloroquine retinopathy / 中华眼底病杂志

Hydroxychloroquine is widely used in a variety of autoimmune diseases. However, long-term use of hydroxychloroquine can cause severe retinopathy, which has a complex pathogenic mechanism and diverse clinical manifestations, mainly manifested as photoreceptor and retinal pigment epithelial damage and irreversible vision loss. Identifying damage before retinitis pigment epithelium lesions preserve central vision, so early detection is crucial to slow disease progression and reduce vision loss. The development of multimodal imaging technology and the issuance of the latest treatment guidelines provide a powerful tool for the early screening and treatment of hydroxychloroquine retinopathy. Proficient in the latest guidelines for the treatment of hydroxychloroquine can better guide clinicians to do a good job in disease screening and management, recommend risks, safe dosages and appropriate screening procedures to patients and strengthen the prevention of hydroxychloroquine retinopathy, which will help save the vision of more patients and reduce the waste of medical resources.

Equity of resource allocation in ophthalmology departments of medical institutions in Shenzhen City / 预防医学

Objective @#To investigate equity of resource allocation in ophthalmology departments of medical institutions in Shenzhen City, so as to provide insights into the optimization of resource allocation in ophthalmology departments in Shenzhen City.@* Methods @#The numbers of beds and ophthalmologists in ophthalmology departments of medical institutions in Shenzhen City were collected through the Shenzhen Health Statistical Yearbook 2019. The distribution of resources and equity of resource allocation were evaluated in ophthalmology departments of Shenzhen City using Lorenz curve and Gini coefficient.@* Results @#There were 5.95 beds and 4.62 ophthalmologists in ophthalmology departments per 100 000 permanent residents in Shenzhen City in 2019. There were 13.35 beds and 9.51 ophthalmologists in ophthalmology departments per 100 000 permanent residents within the former special zone (Luohu, Futian, Nanshan and Yantian districts), and 2.17 beds and 2.13 ophthalmologists in ophthalmology departments per 100 000 permanent residents outside the former special zone (Guangming, Baoan, Longhua, Longgang, Pingshan districts and Dapeng New Area). The Gini coefficients of beds and ophthalmologists in ophthalmology departments were 0.348 and 0.243 by permanent residents in Shenzhen City, 0.386 and 0.386 within the former special zone and 0.086 and 0.012 outside the former special zone, respectively. The Lorenz curves of beds and ophthalmologists in ophthalmology departments were closer to the equity line outside the former special zone in relative to within the former special zone. @* Conclusion@#The gross number of beds and ophthalmologists remains to be increased in ophthalmology departments of medical institutions in Shenzhen City, and the equity of regional resource allocation is poor, which is mainly characterized by resource scarcity in ophthalmology departments outside the former special zone.

Prevalence and spatial characteristics of poor vision among primary school students in Shenzhen / 中华实验眼科杂志

Objective:To analyze the prevalence of poor vision and spatial distribution characteristics among primary school students in Shenzhen.Methods:A cross-sectional study was conducted.Vision screening among primary school students in Shenzhen was carried out by myopia screening hospitals organized by Shenzhen Myopia Prevention and Control Center for Children and Adolescents using the logarithmic visual acuity chart in 2019.The prevalence of poor vision in different districts, different genders and different grades was calculated.Spatial distribution of the prevalence of poor vision was analyzed with Arcgis 10.2 software.This study adhered to the Declaration of Helsinki.Written informed consent was obtained from guardian of each subject.The study protocol was approved by an Ethics Committee of Shenzhen Eye Hospital (No.20201230-06).Results:A total of 1 044 545 students received the visual acuity examination.The prevalence of poor vision among primary school students in Shenzhen in 2019 was 53.4%(557 748/1 044 545). The prevalence of poor vision among primary school students in the former Shenzhen Special Economic Zone was 56.7%(172 771/304 532), which was higher than 52.0%(384 977/740 013) in areas outside the former Shenzhen Special Economic Zone, and the prevalence of poor vision among girls was 56.7%(268 201/473 164), which was higher than 50.7%(289 547/571 381) among boys, and the differences were statistically significant ( χ2=192.412, 375.434; both at P<0.001). As the grade increased, the prevalence of poor vision firstly decreased and then increased, showing an increasing tendency in general.The prevalence rate of poor vision among primary school students among grade 1 to 6 was 49.8%(99 615/200 203), 44.0%(86 521/196 800), 47.2%(82 848/175 331), 54.5%(89 737/164 731), 60.8%(96 271/158 298), and 68.9%(102 756/149 182), respectively, and a significant difference was found ( χ2=2 871.017, P<0.001). The global Moran I index in Shenzhen was 0.278.The local Moran I index and Geary coefficient in Guangming District were 0.933 and 0.78, respectively.The prevalence of poor vision in Guangming District and its surrounding areas was a low-low cluster. Conclusions:The prevalence of poor vision among primary school students in Shenzhen is spatially aggregated.

Advances in research on myopic traction maculopathy / 中华眼底病杂志

High myopia is a disease with a high incidence rate and an increasing trend, which could lead to irreversible visual impairment worldwide. Myopia traction maculopathy (MTM), belonging to one of the pathological changes of high myopia, could cause vision damage and even blindness in patients. Recently, a new classification of MTM based on optical coherence tomography can effectively evaluate the condition of patients and is helpful for the diagnosis and treatment of MTM. Moreover, the improvement of internal limiting membrane peeling method and the innovation of macular buckle material provide new ideas for the treatment of MTM based on traditional surgery. New treatment such as vitreal traction release laser surgery, enzymatic vitreolysis and posterior scleral crosslinking have gained increasing attention. By combining these new treatments with artificial intelligence, 3D printing technology and advanced vitrectomy equipment, it is hoped that a safer and more effective treatment for MTM will be found in the future.

Advances in research on myopic traction maculopathy / 中华眼底病杂志

High myopia is a disease with a high incidence rate and an increasing trend, which could lead to irreversible visual impairment worldwide. Myopia traction maculopathy (MTM), belonging to one of the pathological changes of high myopia, could cause vision damage and even blindness in patients. Recently, a new classification of MTM based on optical coherence tomography can effectively evaluate the condition of patients and is helpful for the diagnosis and treatment of MTM. Moreover, the improvement of internal limiting membrane peeling method and the innovation of macular buckle material provide new ideas for the treatment of MTM based on traditional surgery. New treatment such as vitreal traction release laser surgery, enzymatic vitreolysis and posterior scleral crosslinking have gained increasing attention. By combining these new treatments with artificial intelligence, 3D printing technology and advanced vitrectomy equipment, it is hoped that a safer and more effective treatment for MTM will be found in the future.

Comparison of the thickness of macular ganglion cell inner plexiform layer in patients with a history of laser photocoagulation versus intravitreal injection of ranibizumab for retinopathy of prematurity / 中华眼底病杂志

Objective:To compare the thickness of the macular ganglion cell inner plexiform layer (mGCIPL) in patients with a history of laser photocoagulation (LP) versus intravitreal injection of ranibizumab (IVR) for retinopathy of prematurity (ROP).Methods:A retrospective clinical study. From June 2020 to January 2021, 70 eyes of 35 children with a history of surgery for ROP in Shenzhen Eye Hospital were included in the study. Among them, 18 males had 36 eyes, and 17 females had 34 eyes. The average age was 5.54±1.04 years. There were 18 patients (36 eyes) in LP group and 17 patients (34 eyes) in IVR group. There was no significant difference in age ( t=-1.956), sexual composition ratio ( χ2=0.030), birth gestational age ( t=-1.316) and birth weight ( t=-1.060) between the two groups ( P=0.059, 0.862, 0.197, 0.297). All the eyes underwent the examination of optical coherence tomography (OCT). An elliptical region of 14.13 mm 2 centered on macular fovea was scanned according to the macular cube 512×128 model of the Cirrus HD-OCT 5000. The software was used to automatically divide macular fovea into six sectors (superior, inferior, temporal-superior, temporal-inferior, nasal-superior and nasal-inferior) and the average and minimum thickness of mGCIPL. t test was used to compared mGCIPL thickness between two groups using independent samples. Pearson correlation analysis was used to evaluate the correlation between mGCIPL thickness and age, birth gestational age, birth weight. Results:Patients in IVR group had significantly decreased mGCIPL thickness than that in LP group in the six sectors (superior, inferior, temporal-superior, temporal-inferior, nasal-superior and nasal-inferior) and the average and minimum ( t=6.484, 6.719, 7.682, 7.697, 5.151, 5.008, 7.148, 6.581; P<0.05). The thickness of mGCIPL was not significantly correlated with age, birth gestational age, birth weight ( P>0.05). Conclusion:The thickness of mGCIPL in patients with IVR treatment history is thinner than that in LP treatment.

Progress in the treatment of refractory macular hole / 中华实验眼科杂志

Refractory macular hole (MH) includes large MH, traumatic MH, secondary MH, high myopic MH, unclosed MH and reopening MH.Refractory macular hole (MH) still has low anatomical closure rate and poor recovery of visual acuity after treatment of the current gold standard of pars plana vitrectomy (PPV), induction of posterior vitreous detachment, internal limiting membrane peeling and gas tamponade.Current surgical treatments include extended internal limiting membrane peeling, inverted internal limiting membrane flap, autologous internal limiting membrane transplantation, lens capsular transplantation, autologous neurosensory retinal transplantation, mesenchymal stem cells or exocrine transplantation and vitreous replacement.Stem cells or exocrine transplantation, the application of new long-acting vitreous replacement and the improvement of surgical techniques can promote the in situ healing of macular hole, which is a promising future.At present, the goal of all surgical methods is to induce or help stimulate glial tissue proliferation to enhance MH contraction and repair.Targeted individualized treatment according to the existing evidence-based medical evidence is a future trend.This article reviewed the researches on the treatment of refractory MH in recent years, in order to improve clinician' understanding of refractory MH and provide reference for optimizing and standardizing the treatment scheme.

Ultrastructural and biomechanical characteristics of internal limiting membrane in high myopic macular hole / 中华实验眼科杂志

Objective:To investigate the ultrastructural and biomechanical properties of the internal limiting membrane (ILM) in high myopic macular hole (HM-MH) eyes.Methods:ILM specimens were peeled from 14 eyes with HM-MH from August to December in 2017, and 16 eyes with idiopathic macular hole (IMH) in the same period were served as a control.Specimens were detected by immunefluorescence, transmission electron microscopy (TEM) and atomic force microscopy (AFM). This study followed the Declaration of Helsinki, and was approved by the Ethics Committee of Zhongshan Ophthalmic Center.Results:The immunofluorescence staining results showed that collagen Ⅳ was mainly distributed on the vitreal side and laminin on the retinal side of ILM in both groups.TEM findings revealed that the thickness of ILMs in the HM-MH group was (1.01±0.17)μm, which was significantly decreased compared with (1.92±0.21)μm in the IMH group ( t=12.880, P<0.001). The stiffness of the ILMs in the HM-MH group was (2.86±0.33)MPa, which was significantly higher than (0.88±0.23)MPa in the IMH group ( t=-12.650, P<0.001). The stiffness of the ILMs in the HM-MH group was positively correlated with the axial length ( r=0.832, P<0.001). Conclusions:Compared with IMH, the thickness of ILMs from HM-MH patients is thinner and the stiffness is higher, which contribute to a deep understanding of the pathogenesis of HM-MH.

Surgical outcomes of 27-gauge vitrectomy for rhegmatogenous retinal detachment with air tamponade / 中华实验眼科杂志

Objective To evaluate the efficacy and safety of 27-gauge sutureless vitrectomy with air tamponade for rhegmatogenous retinal detachment (RRD).Methods The clinical data of 35 consecutive eyes with primary RRD from 35 patients who received 27-gauge vitrectomy with intraocular air tamponade in Zhongshan Eye Center from April 2016 to January 2017 were retrospectively analyzed.The mean follow-up duration was 8.6 months.Best corrected visual acuity (BCVA) (LogMAR) and intraocular pressure (IOP) were examined before surgery,1 week and 3 months after surgery.The operative duration,sclerotomy sites,retinal reattachment rate,intraoperative and postoperative complications were recorded.Results The mean duration of vitreous removal was (15.3 ± 3.6) minutes,and the mean duration of operation was (34.5 ± 4.8) minutes.No suturing process was performed at sclerotomy sites in all eyes.The retinal reattachment rate following a single procedure was 100％.The mean BCVA was significantly different among before surgery,1 week and 3 months after surgery (F =64.12,P＜0.01),and the BCVA at 1 week and 3 months after surgery was evidently improved in comparison with before surgery (0.82±0.31 vs.1.01 ±0.40;0.68±0.30 vs.1.01 ±0.40) (both at P＜0.05).The mean IOP was (14.69±3.66),(17.37±2.32) and (16.69±2.45) mmHg (1 mmHg =0.133 kPa) before surgery,1 week and 3 months after surgery,showing a significant difference among them (F=14.82,P＜0.01),and the IOP 1 week and 3 months after surgery was evidently higher than that before surgery (both at P＜0.05).The complications included intraoperative iatrogenic retinal breaks in 2 eyes,postoperative hypotony in 1 eye and hypertension in 5 eyes.These complications were curable.Conclusions 27-Gauge vitrectomy and air tamponade for RRD is an effective and safe approach.